Avoiding complications of the middle vault in rhinoplasty

Pearlman S, Baratelli R.

What this paper says

This review examines the common shape and breathing problems that arise in the middle third of the nose after rhinoplasty, their causes and predisposing factors, and strategies to prevent them; the abstract reports no counts.

Overview

The middle vault is the cartilage section of the bridge between the nasal bones and the tip. It houses the internal nasal valve, and after hump removal it can narrow, collapse or become uneven. The authors state that these problems are frequent reasons for revision and review the common after-effects, their likely causes and the factors that make a patient prone to them.

Sections of note

Review article; no series, rates or outcome data appear in the abstract.
Functional and aesthetic abnormalities of the middle vault are described as frequent reasons for seeking revision rhinoplasty.
The authors state that complications in rhinoplasty are inevitable but that understanding causes can reduce them.
Topics: common sequelae, likely causes, predisposing factors and prevention strategies.
The specific complications and preventive techniques are not listed in the abstract.

What it means for a patient

The section of the nose just below the bones is where breathing problems and a pinched or inverted-V look most often develop after surgery.
Some noses, such as those with short nasal bones or thin skin, are more at risk, and the surgeon can plan support in advance.
The abstract gives expert guidance only, with no figures on prevention success.

Why this paper matters

Middle vault collapse after hump removal was a major driver of revision in the reduction era and led to spreader grafts and, later, dorsal preservation. This article summarizes prevention thinking as of 2012. Comparative outcome data are not presented.

Terms

Middle vault: the cartilage section of the bridge between the nasal bones and the tip, formed by the upper lateral cartilages and septum.
Internal nasal valve: the narrowest part of the airway, between the septum and the upper lateral cartilage.
Inverted-V deformity: a visible V-shaped shadow where the nasal bones end, caused by the upper lateral cartilages falling inward.
Spreader graft: a cartilage strip placed between the septum and upper lateral cartilage to hold the middle vault open.
Sequela: a condition that follows as a consequence of surgery or disease.
Revision rhinoplasty: a repeat operation on a nose that has already had surgery.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Functional and aesthetic abnormalities of the middle nasal vault are frequent reasons for seeking revision rhinoplasty. Complications in rhinoplasties are inevitable; understanding their etiology can help reduce their occurrence. We will examine the more common sequelae, likely causes, and predisposing factors as well…”

Excerpt; the full abstract is on PubMed.